Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea.
Clin Orthop Surg. 2021 Dec;13(4):468-473. doi: 10.4055/cios20294. Epub 2021 Jul 28.
Intertrochanteric fractures are one of the most common fractures in the elderly, especially those having osteoporosis. Stable intertrochanteric fractures may be fixed with implants including the dynamic hip screw and proximal femoral nail antirotation; however, this method is difficult to apply to unstable fractures. Bipolar hemiarthroplasty can be applied to unstable fractures and it prevents complications by facilitating early ambulation in the elderly. Many studies reported on how to fix the greater trochanter in unstable fractures during arthroplasty. We suggest that suture fixation alone can be a useful, effective, and affordable method.
We retrospectively enrolled 294 patients who underwent hemiarthroplasty for an unstable intertrochanteric fracture, and 225 patients were included in this study after excluding 69 patients who had not been available for follow-up until 1 year after surgery or died. The patients were divided into suture fixation and wiring fixation groups. Relationships of operation time, estimated blood loss, tip-to-stem distance, union rate, and physical performance in the groups of suture fixation and wiring were analyzed respectively.
Changes in the tip-to-stem distance between the initial assessment at 1 year after surgery were statistically significantly different between the suture fixation group and wiring group ( < 0.001). There was no significant difference in change of the Koval score between the suture fixation and wiring groups ( = 0.362). The operation time and estimated intraoperative blood loss were statistically significantly lower in the suture group than in the wiring group ( < 0.001). There was no significant difference in the union rate between the groups ( = 0.470).
Compared to tension-band wiring, the suture fixation technique demonstrated an effective fixing force. In addition to the clinical results, it had an advantage of preventing complications due to shortening of the operation time and estimated intraoperative blood loss. Suture fixation of the greater trochanter is recommended for elderly patients with unstable intertrochanteric fractures.
股骨转子间骨折是老年人最常见的骨折之一，尤其是骨质疏松症患者。稳定的股骨转子间骨折可以通过使用动力髋螺钉和股骨近端防旋髓内钉等植入物进行固定；然而，这种方法对于不稳定的骨折难以应用。双极人工股骨头置换术可应用于不稳定的骨折，通过促进老年人早期活动，预防并发症。许多研究报告了在关节置换术中如何固定大转子以治疗不稳定的骨折。我们建议，单独缝线固定是一种有用、有效且经济实惠的方法。
我们回顾性纳入了 294 例因不稳定股骨转子间骨折行人工股骨头置换术的患者，排除了 69 例术后 1 年随访未到或死亡的患者后，共 225 例患者纳入本研究。将患者分为缝线固定组和钢丝固定组，分析两组手术时间、失血量、尖顶距变化、愈合率和术后 1 年的生活质量评分。
术后 1 年时，缝线固定组与钢丝固定组的尖顶距变化差异有统计学意义（<0.001）。缝线固定组与钢丝固定组的 Koval 评分变化差异无统计学意义（=0.362）。缝线固定组的手术时间和术中估计失血量明显低于钢丝固定组（<0.001）。两组的愈合率差异无统计学意义（=0.470）。
与张力带钢丝固定相比，缝线固定技术具有有效的固定力。除了临床效果外，缝线固定还具有缩短手术时间和减少术中估计失血量的优势。建议对不稳定股骨转子间骨折的老年患者采用大转子缝线固定。
